Homero Ango-Aguilar

Background/Objectives: The 2024 WHO guidelines incorporated the APRI index into treatment decisions for chronic hepatitis B, with thresholds of >0.5 for significant fibrosis and >1.0 for cirrhosis, because it can be computed when neither biopsy nor elastography is available. The evidence supporting those thresholds derives almost entirely from studies using liver biopsy as reference standard; how serological indices behave when the available comparator is elastography remains unknown, and no data exist for Andean populations. We aimed to quantify the agreement of APRI and FIB-4 with transient elastography, determine whether either discriminates better, and evaluate the 2024 WHO thresholds in this setting. Methods: Retrospective agreement study of patients in the Hepatitis B Elimination Plan of Huanta, Peru. APRI and FIB-4, computed from routine laboratory results, were compared against transient elastography (FibroScan 402, M+ probe) used as a reference standard given the unavailability of biopsy. Outcomes followed the 2024 WHO thresholds: >7.0 kPa for significant fibrosis and >12.5 kPa for cirrhosis. Only examinations meeting the pre-specified quality criterion (at least 10 valid measurements; IQR/median ≤ 30%) were analyzed. Diagnostic properties were estimated with exact confidence intervals and likelihood ratios, areas under the curve with bootstrap intervals, and the between-index comparison with DeLong’s test for paired curves. Reporting followed STARD 2015. Results: Of 92 patients, 73 had a valid elastography examination; APRI was computable in 60 and FIB-4 in 57. Prevalence was 23.3% (95% CI 14.2–34.6) for significant fibrosis and 12.3% (5.8–22.1) for cirrhosis. For significant fibrosis, APRI > 0.5 achieved 61.5% sensitivity (31.6–86.1) and 74.5% specificity (59.7–86.1), with a positive likelihood ratio of 2.41 (1.26–4.62) and a negative one of 0.52 (0.25–1.05). For cirrhosis, APRI > 1.0 yielded 71.4% sensitivity, 92.5% specificity and a positive likelihood ratio of 9.46 (3.30–27.11). Areas under the curve were 0.844 and 0.808 for significant fibrosis and 0.914 and 0.874 for cirrhosis; DeLong’s test detected no statistically significant difference between indices at either level (p = 0.47 and 0.53); however, the limited number of outcome-positive cases (13 and 7, respectively) means that clinically important differences cannot be excluded and equivalence has not been established. Conclusions: APRI and FIB-4 identified cirrhosis with likelihood ratios large enough to act on but were only weakly informative at the threshold that governs treatment eligibility, where the negative likelihood ratios did not exclude unity. Neither index can be used as a stand-alone rule-out test at that threshold. The small number of outcome-positive cases limits precision throughout. Although the program intended both assessments to occur during the same session, individual dates were unavailable, preventing verification of the actual interval between elastography and blood sampling.

Hepatitis B virus (HBV) infection remains a major public-health challenge in Peru, particularly in historically hyperendemic Amazonian and Andean regions; however, the structure, evolution, and equity of national HBV research have not been systematically evaluated. We conducted a PRISMA-informed bibliometric analysis of all peer-reviewed and theses on HBV in Peru published between 1988 and 2023 using Scopus, Google Scholar, and the Peruvian National Repository (RENATI). Bibliometric indicators, collaboration networks, thematic structure, and temporal thematic evolution were analyzed in R using bibliometrix- and network-based approaches. The final corpus comprised 232 documents, with a marked increase in production after 2005 and a publication peak in 2018. Scientific output was strongly concentrated in Lima-based institutions, while several departments historically associated with HBV endemicity exhibited minimal or absent research production. Nearly half of the corpus corresponded to undergraduate and postgraduate theses. Thematic analyses revealed persistent predominance of epidemiology, seroprevalence, and vaccination-related research, whereas molecular virology, therapeutics, and translational research remained peripheral or poorly represented. International collaboration was markedly limited. Overall, Peruvian HBV research has expanded quantitatively but remains geographically centralized and shows only limited correspondence with the contemporary geographic distribution of HBV incidence, while also remaining only partially aligned with the contemporary global HBV research frontier. These findings provide an evidence-based framework to guide research-priority setting, territorial equity policies, and strategic investment in infectious disease research capacity in Peru. Moreover, the weak association observed between scientific production and departmental HBV incidence suggests that factors beyond contemporary epidemiological burden contribute to the current distribution of research activity in Peru, highlighting a critical but often overlooked dimension of health inequity in low- and middle-income countries (LMIC) research systems.

Scientific output in health sciences has grown exponentially, yet its landscape remains under-analyzed in emerging economies. In Peru, Microbiology and Parasitology are disciplines of strategic relevance for public health, but no specific bibliometric analysis exists. This study provides the first baseline to identify thematic gaps and characterize research patterns within the SciELO Peru collection. Through a descriptive bibliometric analysis of 549 Microbiology and Parasitology articles indexed in the SciELO Peru collection (2000–2023), temporal, regional, and institutional indicators, methodological design, and journal characteristics were evaluated using R v4.4.0. Results show that production peaked in 2021, coinciding with the COVID-19 pandemic period and accompanied by a marked increase in Virology-related publications. Lima accounted for 77.3% of the SciELO Peru corpus national output, with UPCH (17.5%), INS (14.9%), and UNMSM (13.7%) leading institutional activity. Bacteriology was the dominant area (44.1%), while Mycology was the most underrepresented (2.4%), and cross-sectional designs predominated (63.9%). Notably, real international collaboration was limited to 1.8%, and RPMESP was the sole Bradford core journal, accounting for 48.5% of the corpus, with no articles appearing in Q1 journals. These findings reveal that while production shows sustained growth, it is marked by high geographic concentration and a scarcity of applied technological research within the analyzed corpus. These findings highlight the urgent need to decentralize research and reorient Peru’s health science agenda toward critical, under-studied disciplines.

Hepatitis B virus (HBV) genotype F is one of the most genetically divergent and evolutionarily ancient HBV lineages and predominantly circulates in indigenous and admixed populations of the Americas. Here, we performed a comprehensive evolutionary and inferred functional characterization of the HBV genotype F via the largest curated dataset of complete genomes. Phylogenomic reconstruction, recombination screening, and phylogenetic network analyses were integrated with codon-based selective pressure inference, surface protein posttranslational modification profiling, mutational analysis of antigenic regions, and reverse transcriptase (RT) drug resistance assessment. The HBV-F subgenotype exhibited a well-resolved phylogenetic structure and limited intragenotypic recombination, while intergenotypic recombination contributed substantially to reticulate evolutionary signals. Selective pressure analyses revealed strong purifying selection in replication-associated domains of the polymerase, in contrast to episodic adaptive evolution in surface-exposed and regulatory proteins, particularly the X protein. N-glycosylation sites in large surface proteins are highly conserved. Some mutations in the major hydrophilic region (MHR) were significantly detected, whereas RT drug resistance mutations were rare and followed canonical lamivudine-associated pathways. Collectively, these findings highlight the balance between deep evolutionary conservation and localized adaptive flexibility in shaping the HBV genotype F and provide a genotype-specific framework for interpreting viral fitness, immune interactions, and antiviral resistance.

Background: Monkeypox (Mpox) is a re-emerging zoonotic disease caused by the monkeypox virus (MPXV). Transmission occurs primarily through direct contact with lesions or contaminated materials, with sexual transmission playing a significant role in recent outbreaks. In 2022, Mpox triggered a major global outbreak and was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), prompting renewed interest in effective control strategies. Methods: This study developed a compartmental SEIR-based model to assess the epidemiological impact of key interventions, including vaccination and isolation, while incorporating critical epidemiological parameters. Sensitivity analyses were conducted to examine (1) disease dynamics in relation to the basic reproduction number, and (2) how different parameters influence the curve of symptomatic infections. Real-world continental-scale data were used to validate the model and identify the parameters that most significantly affect epidemic progression and potential control of Mpox. Results: Results showed that the basic reproduction number was most influenced by the recovery rate, vaccination rate, vaccine effectiveness, and transmission rates of symptomatic and asymptomatic individuals. In contrast, the progression of symptomatic cases was highly sensitive to the case fatality rate and incubation rate. Conclusions: These findings highlight the importance of integrated public health strategies combining vaccination, isolation, and early transmission control to mitigate future Mpox outbreaks.

Hepatitis B virus (HBV) infection remains a global public health concern, with perinatal transmission as the primary route in endemic populations. Ayacucho is a priority region due to its high incidence (second nationally between 2019 and 2024) and the significant decline in vaccination coverage (~15%). This study aims to synthesize existing epidemiological evidence on HBV seroprevalence in Ayacucho, Peru, emphasizing temporal changes observed before and after the implementation of vaccination programs to inform control strategies. This review was conducted, integrating data from diverse population groups, including children, pregnant women, blood donors, high-risk individuals (military personnel, female sex workers, prisoners), and household contacts, to identify transmission patterns and evaluate the impact of immunization efforts. Historically, Ayacucho was hyperendemic, with an HBsAg prevalence of 20% in Huanta (1985–1986) and a high mortality from liver diseases. The introduction of a vaccination in the 1990s led to a drastic reduction in infection rates among children, from 24.4–30.4% (1994) to 2.3–5.1% (1997), and improved overall Expanded Program on Immunization (EPI) coverage. However, recent data (2000–2024) reveal a concerning increase in HBV cases since 2012, with peaks in 2016 and 2023, correlating with a decline in vaccination rates post-2021. HBV prevalence remains elevated among high-risk populations—including military personnel, female sex workers, and prisoners—as well as among blood donors (HBsAg: 3.73–5.0%; anti-HBc: 21–33%). In addition, significant knowledge gaps and low adherence to EPI strategies were observed. Despite initial vaccination success, Ayacucho faces a resurgence of HBV infection, exacerbated by declining vaccine coverage and vulnerabilities in high-risk populations. Reinforcing immunization programs and screening strategies is urgent to control and eventually eliminate HBV cases in the region.

We used an interbehavioral model of teacher–student didactic performance with six pairs of criteria, as follows. Exploration of competencies and precurrent for learning, explicitness of teacher criteria and identification of student criteria, teacher illustration and illustration—student participation, supervision of the practice by the teacher and pertinent student practice, teacher feedback and feedback—student improvement, and teacher evaluation and evaluation—student application. The objective was to determine the level of covariation, divergence and convergence between the constructs of teacher didactic performance and student didactic performance in virtual classes as a result of the SARS-CoV-2 pandemic, in November 2020. Three hundred-thirty undergraduate students of biological sciences from a public university in Peru completed two self-report scales in virtual modality through Google forms, one on the performance of their teachers and the other on their own performance. By means of confirmatory factor analysis and an analysis of the covariance of teacher–student performance constructs, three models were obtained with good fits for the convergent and divergent validities of six constructs of the two teaching performance scales. Adequate models of functional correspondence in each pair of the six teacher–student didactic performance criteria were obtained. Likewise, didactic performances related to the identification of teaching–learning criteria and to the evaluation—application criteria were the most frequent during teaching–learning, according to the students’ self-report.

There is significant educational research interest regarding the assessment of the benefits of virtual education implemented during the COVID-19 pandemic for university programs that were essentially face-to-face. The objective of the study was to determine the effect of the management of online resources that the teacher had on the valuation of the advantages of online classes in biological sciences, mediated by the students’ perception of virtual practices as well as the accessibility and use of online resources. A total of 332 Peruvian students studying in biological sciences from a public university, enrolled in five undergraduate academic years, of which 184 were women and 148 were men, participated. A non-experimental predictive design of causal relationships was used with the methodology of structural equation modeling. According to the SEM model (CFI and TLI > 0.95, RMSEA and SRMR < 0.05), the valuation of the advantages of virtual classes during the pandemic was significantly predicted by the valuation of virtual practices (positively) as well as by the accessibility and management of online resources by students (negatively); likewise, the use and mastery of digital and online resources by teachers had an indirect effect on the valuation of virtual classes, but direct effects on virtual practices and accessibility to digital resources by students. Also, virtual practice was the most crucial variable in predicting the valuation of online classes (β = 0.48, p < 0.001). In conclusion, the student’s perception of the teachers’ handling of online resources during the COVID-19 pandemic was determinant as a favorable valuation of the advantages offered by online classes, a relationship that is mediated by virtual practices and accessibility to online resources.